Substitute Decision Makers and Naming a Power of Attorney for Personal Care

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1 Substitute Decision Makers and Naming a Power of Attorney for Personal Care Information for patients and families Read this booklet to learn: what a Substitute Decision Maker (SDM) is what an Power of Attorney for Personal Care is how to name an attorney for personal care how your health care team will use your information where to find more information UHN Please visit the UHN Patient Education website for more health information: University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only. Author: A joint collaboration by Patient Education, Social Work, Bioethics, and Medical Imaging Revised: 12/2014 Form: D-5619

2 Sometimes a person is not able to make their own health care decisions because they are ill or were in an accident. It s important to understand how decisions about your medical care will be made if this happens to you. What is a substitute decision maker (SDM)? An SDM is a person who can legally make health care decisions on your behalf if you are not able to understand or appreciate the necessary information. Your SDM s role is to make care decisions for you consistent with your wishes. When your wishes are not known or do not apply to your health care situation, your SDM's role is to make decisions that are in your best interests. Who is my SDM if I m not able to make health care decisions? You don t have to choose your SDM. The law lists, in order, the person (or people) who can be your SDM if you are not able to consent (agree) to treatment. 1. A guardian with the power to give or refuse consent to treatment 2. An attorney for personal care with the power to give or refuse consent to treatment 3. A person chosen by the Consent & Capacity Board 4. A spouse or partner 5. A child (over 16 years of age) or parent or a worker from the Children s Aid Society 6. A parent with right of access only 7. A brother or sister (or if more than one sibling, brothers and sisters together) 8. Any other relative (related by blood, marriage or adoption) 9. The Office of the Public Guardian and Trustee (OPGT) OPGT is part of the Ontario Ministry of the Attorney General. This office will make decisions about your care only if no other person on this list is able, willing or available to give or refuse consent. 2

3 In this case, the health care worker proposing the treatment must talk to the first person on this list. If there isn t such a person, or if this person is not able, willing, or available to make health care decisions for you, the health care worker must ask the second person on the list. This continues until an SDM is identified from this list. You could have joint SDMs. For example, if you have 2 children willing to be an SDM, they would have to both make decisions about your care. They would need to agree on the same health care decisions for you. What if I want to choose exactly who will make health decisions for me? If you want to choose the person who will be your SDM, you can make them your attorney for personal care. An attorney for personal care is someone you trust and legally choose to make health decisions for you if you are not able of make them for yourself. Who can I choose to be my attorney for personal care? This person (or people) could be someone from the list above. Or, you could choose someone else, such as a close friend or a neighbour. You can choose anyone you like, but they can t be: under 16 years old unable to understand or appreciate information about the treatment decisions proposed for you someone who is paid to give you health care or other support services If you choose more than one person, you need to specify whether they need to make the decision together, or if one can make the decision by themselves if the other(s) are not available. 3

4 How do I make someone my attorney for personal care? To legally make someone your attorney for personal care, you must complete a Power of Attorney for Personal Care. This is a form that gives someone you trust the legal power to make health care decisions for you if you are not able to make them for yourself. When the form is complete, your attorney for personal care will become your SDM when you are incapable of making health care decisions. You will make decisions for yourself until you are not able to do so. If you have an attorney for personal care, your health care team will contact this person first to make health care decisions for you if you are unable to make them for yourself. What should I talk to my SDM about? Choosing who you trust to make health care decisions for you if you are unable to make them for yourself is part of advance care planning. Advance care planning also includes thinking about, talking about and writing down what you would like to happen if your SDM has to make decisions for you. Talk to your SDM about: any values and preferences that could help guide them if they have to make decisions for you what medical treatment and care you would and wouldn t want if you became very ill You can also write down these values, preferences and treatments in a document called an Advance Directive. An Advance Directive helps make it clear to your SDM and health care providers what medical treatment and care you would and wouldn t want. 4

5 How do I get the paperwork for a Power of Attorney for Personal Care and an Advance Directive? You can contact a lawyer to help you make a Power of Attorney for Personal Care. You can get a Power of Attorney for Personal Care kit from the Ministry of the Attorney General. Download the kit by visiting the website: or call the office to ask them to mail you a kit: Phone: (if you live in Toronto) or (free call outside of Toronto) University Health Network (UHN) has Power of Attorney for Personal Care kits and Advance Directive books. You can find these on the UHN website: or in the UHN Social Work and Discharge Planning offices. Go to the end of this booklet to find the phone numbers you can call. If you are staying overnight at UHN, a hospital social worker on your unit can help you to get this paperwork and answer any questions you may have. Please note: UHN staff cannot sign any paperwork as a witness. Advance Directive booklets and other information is available at the website: When should I give my Power of Attorney for Personal Care and Advance Directive information to my health care team? Give a copy of your Power of Attorney for Personal Care or Advance Directive paperwork to your attorney for personal care to keep. This way, they can give them to your health care providers if they need to. 5

6 If you need to come to UHN for care (such as a visit to the Emergency Department or the Admitting Department) give your health care team the name and telephone number of your attorney for personal care as soon as you can. Give your health care team a copy (not the original) of your Power of Attorney for Personal Care or Advance Directive paperwork. At UHN, we want to make sure that you have the person you want making decisions about your health care. Remember to tell your health care team if you have an attorney for personal care and who it is. It s a good idea to let someone else close to you know this information, so they can also tell your health care team if they need to. Where does the information go? We record any information you give us in your private health record. This way, all health care providers who are part of your care at UHN are able to get it quickly if they need to. How will my health care team use this information? If you are unable to make health care decisions for yourself, your health care team will talk to your attorney (or attorneys) for personal care. They will talk about your health care plan, treatments and procedures and your instructions, including any you wrote in your Advance Directive. Your attorney for personal care will make care decisions for you until you are able to make decisions for yourself. 6

7 Who can I talk to if I have questions? UHN has many team members who can help you learn more about SDMs and attorneys for personal care. Call them anytime, or ask a health care team member to call for you. UHN Social Work and Discharge Planning Offices: Toronto General Hospital Phone: , extension 5969 Toronto Western Hospital Phone: , extension 6461 Princess Margaret Cancer Centre Phone: , extension 4971 Toronto Rehab: Please contact the social worker on your health care team. UHN Bioethics Program: Toronto General Hospital Linda Wright, MHSc, MSW, RSW Director Phone: , extension linda.wright@uhn.ca Barbara Russell, PhD, MBA Senior Bioethicist Phone: , extension barbara.russell@uhn.ca Toronto Western Hospital Kyle Anstey, PhD Senior Bioethicist Phone: , extension kyle.anstey@uhn.ca Toronto Rehab Ann Heesters, MA Senior Bioethicist Phone: , extension ann.heesters@uhn.ca 7

8 Princess Margaret Cancer Centre Jennifer Bell, PhD Bioethicist Phone: , extension Multi-Organ Transplant Daniel Buchman, PhD MSW, RSW Bioethicist Phone: , extension You can also contact UHN Patient & Family Libraries for free booklets on substitute decision making, attorneys for personal care or advance care planning: The Princess Margaret Cancer Centre Patient & Family Library Main Floor, Atrium 610 University Avenue Phone: , extension Toronto General Hospital Peter and Melanie Munk Patient & Family Learning Centre and Library Norman Urquhart Building Level University Avenue Phone: , extension tgpen@uhn.ca Toronto Rehab University Centre Sun Life Patient & Family Resource Centre Main Floor, Room University Avenue Phone: , extension torontorehabhealthinfo@uhn.ca 8

9 Toronto Western Hospital Paul B. Helliwell Patient & Family Library West Wing 1st floor 399 Bathurst Street Phone: Other helpful resources Power of Attorney for Personal Care Community Legal Education Ontario (CLEO) Website: The Advance Care Planning Workbook - Ontario Version Speak Up Website: 9